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- Title
Intravenous Immunoglobulin Therapy for Active, Extensive, and Medically Refractory Idiopathic Ulcerative or Crohn's Colitis.
- Authors
Levine, Douglas S.; Fischer, Susanna H.; Christie, Dennis L.; Haggitt, Rodger C.; Ochs, Hans D.
- Abstract
To determine whether intravenous immunogtobulin produces demonstrable clinical improvement in patients with refractory idiopathic inflammatory bowel disease, a pilot, open-label, nonrandomized, safety and therapeutic efficacy study was carried out at a tertiary care referral medical center. Twelve consecutive patients with refractory idiopathic colitis (nine ulcerative colitis, three Crohn's colitis) who were reluctant to receive immunosuppressive therapy or have surgical intervention were referred by physicians not participating as investigators in this study. Eleven patients were symptomatic for at least 6 months, with endoscopically moderate or severe mucosal inflammation despite medical therapy, including systemic corticosteroids in all cases, and one patient was dependent on oral prednisone to remain in clinical remission. Ten patients had extensive colitis, six of whom had pancolitis and four of whom had colitis extending to the hepatic flexure or transverse colon. Nine patients required hospitalization for treatment of colitis. Intravenous immunoglobulin was administered in one or two induction phases (2 g/kg over 2 or 5 days), followed by a maintenance phase (200-500 mg/ kg every 2 wk for 12 or 24 wk). Tapering of systemic corticosteroid therapy was attempted, whereas other medications for idiopathic colitis were continued. Treatment response was assessed clinically and by colonoscopy with multiple biopsies whenever possible. Immunoglobulin therapy was well-tolerated and did not produce any biochemical abnormalities. In six patients who completed the treatment protocol, mean reductions ± SE were achieved in subjective symptoms as quantified by a colitis activity score, 13.3 ± 1.2 to 4.7 ± 0.9 (p < 0.001), and daily mg dose of prednisone, 41.7 ± 8.0 to 1.9 ± 1.2 (p < 0.001). For all 12 patients, statistically significant reductions were achieved in the colitis activity score and daily prednisone dose. Of five...
- Subjects
IMMUNOGLOBULINS; INFLAMMATORY bowel diseases; COLITIS; THERAPEUTICS; MEDICAL centers; PATIENTS
- Publication
American Journal of Gastroenterology (Springer Nature), 1992, Vol 87, Issue 1, p91
- ISSN
0002-9270
- Publication type
Article